Main description:

The state of health care is reflected by perinatal and neonatal morbidity and mortality as well as by the frequencies of long-term neurologic and developmental disorders. Many factors, some without immediately rec ognizable significance to childbearing and many still unknown, undoubt edly contribute beneficially or adversely to the outcome of pregnancy. Knowledge concerning the impact of such factors on the fetus and sur viving infant is critical. Confounding analyses of pregnancy outcome, especially these past two or three decades, are the effects of newly un dertaken invasive or inactive therapeutic approaches coupled with the advent of high technology. Many innovations have been introduced with out serious efforts to evaluate their impact prospectively and objectively. The consequences of therapeutic misadventures characterized the past; it seems they have been replaced to a degree by some of the complications of applied technology. Examples abound: after overuse of oxygen was recognized to cause retrolental fibroplasia, its restriction led to an in crease in both neonatal death rates and neurologic damage in surviving infants. Administration of vitamin K to prevent neonatal hemorrhagic disease, particularly when given in what we now know as excessive dos age, occasionally resulted in kernicterus. Prophylactic sulfonamide use had a similar end result. More recent is the observation of bronchopul monary dysplasia as a complication of respirator therapy for hyaline membrane disease.

Contents:

1 Nutritional Supplementation of the Growth-Retarded Fetus: Rationale, Theoretical Considerations, and in Vivo Studies.- 1. Introduction.- 2. Rationale for Considering Nutritional Therapy.- 2.1. Normal Fetal Growth and Nutrition-A Brief Review.- 2.2. The Growth-Retarded or Small-for-Gestational-Age Infant.- 2.3. Summary of Rationale for Supplementation.- 3. Theoretical Considerations in Providing Nutritional Supplementation.- 3.1. Potential Toxicity.- 3.2. Routes of Supplementation.- 4. Fetal Nutritional Supplementation: Human and Animal Studies.- 4.1. Supplementation via Intra-amniotic Administration of Nutrients.- 4.2. Supplementation via Gastrointestinal Administration of Nutrients.- 4.3. Supplementation via Intravascular Administration of Nutrients.- 4.4. Utilization of Administered Nutrients.- 5. Conclusions.- References.- 2 Transplacental Toxicity of Environmental Chemicals: Environmental Causes and Correlates of Spontaneous Abortions, Malformations, and Childhood Cancer.- 1. Introduction.- 2. Environmental Chemicals and Spontaneous Abortions.- 2.1 Occupational and Social Correlates of Spontaneous Abortions.- 2.2. Health Care Personnel.- 2.3. Laboratory Workers and Solvents.- 2.4. Workers in the Metals Industry.- 2.5. Workers in the Chemicals and Plastics Industry.- 2.6. Workers in the Rubber Industry.- 2.7. 2,4,5-T and TCDD.- 2.8. Other Occupational Groups.- 2.9. Air Pollution.- 3. Environmental Chemicals and Malformations.- 3.1. Occupational and Social Correlates of Malformations.- 3.2. Health Care Personnel.- 3.3. Laboratory Work and Solvents.- 3.4. Metals Industry.- 3.5. Methylmercury.- 3.6. Kanechlor (Polychlorinated Biphenyls).- 3.7. Potato Blight.- 3.8. Soft Water.- 3.9. 2,4,5-T and TCDD.- 3.10. Vinyl Chloride.- 3.11. Water Fluoridation.- 4. Parental Occupation and Cancer in the Offspring.- 5. Conclusions.- References.- 3 Neonatal Polycythemia and Hyperviscosity.- 1. Introduction.- 2. Definition.- 3. Incidence.- 4. Viscosity.- 4.1. Definition.- 4.2. Factors Affecting in Vitro Viscosity Measurements.- 4.3. Factors Affecting Blood Viscosity in Vivo.- 5. Hemodynamic Changes in Polycythemic and Hyperviscous States.- 5.1. Cardiopulmonary Blood Flow.- 5.2. Gastrointestinal Blood Flow.- 5.3. Renal Blood Flow.- 5.4. Carcass Blood Flow.- 5.5. Brain Blood Flow.- 5.6. Fetal Blood Flow.- 6. Etiology.- 7. Clinical Symptoms.- 7.1. Blood Volume and Body Water.- 7.2. Cardiopulmonary Symptoms.- 7.3. Gastrointestinal Symptoms.- 7.4. Renal Function.- 7.5. Hypoglycemia.- 7.6. Hematologic Complications.- 7.7. Neurologic Manifestations.- 8. Management.- References.- 4 Maternal Psychoactive Substance Use and Its Effect on the Neonate.- 1. Introduction.- 1.1. Methodologic Considerations.- 1.2. Studies in Animals.- 2. Cigarette Smoking.- 2.1. Introduction.- 2.2. Pharmacology.- 2.3. Studies in Animals.- 2.4. Studies in Humans.- 2.5. Summary.- 3. Caffeine.- 3.1. Introduction.- 3.2. Pharmacology.- 3.3. Studies in Animals.- 3.4. Studies in Humans.- 3.5. Summary.- 4. Alcohol.- 4.1. Introduction.- 4.2. Pharmacology.- 4.3. Studies in Animals.- 4.4. Studies in Humans.- 4.5. Prenatal Intervention.- 4.6. Summary.- 5. Marijuana Use.- 5.1. Introduction.- 5.2. Pharmacology.- 5.3. Studies in Animals.- 5.4. Studies in Humans.- 5.5. Summary.- 6. Opiate Use.- 6.1. Introduction.- 6.2. Pharmacology.- 6.3. Studies in Animals.- 6.4. Studies in Humans.- 6.5. Follow-up Studies.- 6.6. Prenatal Intervention.- 6.7. Summary.- 7. Amphetamines.- 7.1. Introduction.- 7.2. Pharmacology.- 7.3. Studies in Animals.- 7.4. Studies in Humans.- 7.5. Summary.- 8. Cocaine.- 8.1. Introduction.- 8.2. Pharmacology.- 8.3. Studies in Animals.- 8.4. Studies in Humans.- 9. Barbiturates.- 9.1. Introduction.- 9.2. Pharmacology.- 9.3. Studies in Animals.- 9.4. Studies in Humans.- 9.5. Summary.- 10. Phencyclidine.- 10.1. Introduction.- 10.2. Pharmacology.- 10.3. Studies in Animals.- 10.4. Studies in Humans.- 11. Diazepam.- 11.1. Introduction.- 11.2. Pharmacology.- 11.3. Studies in Animals.- 11.4. Studies in Humans.- 11.5. Summary.- 12. Summary.- References.- 5 Effect of Maternally Administered Drugs on the Fetus and Newborn.- 1. Introduction.- 2. Background Information.- 2.1. Maternal Physiologic Considerations.- 2.2. Drug Effects on the Uteroplacental Blood Flow.- 2.3. Placental Transfer of Drugs.- 2.4. Fetal Monitoring during Labor.- 2.5. Newborn Examinations.- 3. Methods of Pain Relief.- 3.1. Vaginal Delivery.- 3.2. Cesarean Delivery.- 4. Anesthesia and the Compromised Fetus.- 5. Relationship of Obstetric Anesthesia to Long-Term Neonatal Effects.- References.- 6 Chlamydial Infection.- 1. Introduction.- 2. Organism.- 3. Epidemiology.- 4. Perinatal Infections.- 4.1. Perinatal Outcome.- 4.2. Postpartum Endometritis.- 5. Neonatal Infections.- 5.1. Conjunctivitis.- 5.2. Pneumonia.- 5.3. Other Infections.- 6. Diagnosis.- 7. Therapy.- 7.1. Neonatal Eye Prophylaxis.- 7.2. Neonatal Treatment.- 7.3. Maternal Treatment.- References.